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rs• APPLICATION� ,n FOR SANITATION PERMIT Permit No. (Complete in Duplicate] This Permit Expires 1 Year From Date Issued Date Issued plication is hereby made to the San Joaquin Local Health District for permit s q p m t to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION --------------------------------------------------------- Owner's Name_______ - _ - ---------- [ - ---•----------------------------------------------------------- ------------- Y-------------- Address _ .. ---- --- ------------------------------------------------------------------- Contractor's Name----°-fil` !. t _ -� --------------------------------------------------------------- Phone 1 all Installation will serve: Residence Xi Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livin units: __ ._ Number of bedrooms Number of baths __/-__ Lot size -_-___. 9 k _ _ � 0 Water Supply: Public system ❑ Community 'system ( Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ' Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ NoN FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ; (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well-,.-_______- Distance from foundation ___________________Material--____-.____-_----_-_-___--__-.-_.._____-_.___. ❑ No. of compartments--------------------------Size------ = - ------Liquid depth--------------------------Capacity-----------•----------- Disposal Field: Distance from nearest well-W,t�r.gie-,Distance from foundation,__: Distance to nearest lot line___. Number of lines------ ______________________ __Length of each line-_��______ -------- Width of trench--_ ��--"---__-___-_____-.- ' Type of filter material----. .c�±r� ,;_Depth of filter material-___- " Total length___,�-o_____________________________ Ir w Seepage Pit; Distance to nearest well_____ y� '=Distance fr fou dation-_.__ Distance to nearest lot line_f4 Number of pits........ material-___ . __ ___ _ .Size: Diameter__44 _.Depth------- Cesspool: Distance from nearest well-________________Distance from foundation------------------- Lin ng material__--..__________._..__--____._-____- .❑, Size: Diameter.--r----3----------------------------Depth--------------------- ------------------ ------Liquid"Capacity---------------------- gals. I ; Priv.y,: Distance from nearest well------------------------------------------------- from nearest buildin g ---------- — E-❑ Distance to nearest lot line------------------------------------------------------------------•-------------•--•--------- --------------------------------------------- Remodeling and/or repairing (describe)--------------------------------------------------------------------------------------•--------- ------------------------------------------------------- i --------------------------------------------------------------- ------------------------------------------•------------------•---•------------------ ---------------- ____________________________________________________.__________. . -___________________.__.»____________________ 3.______________-_--____-____________-_.---.-___--____--______._.______ _______________________________________________________________r_--______-__-___-___-_______________--_---_________-_--_-_____-_-___-______--_________-___--_-__-___________.-___--____--____--___..__.____--._---.-__--______ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. �= (Signed) -- 9 ) - � ---------------------------------------- By:— , ---: --[Owner arrd/or Contractor) By:------------------------- :.. , - =---'-". (Ti+le) '° (Plot plan, showing size of lot, location of system in relatio'onn to wells, buildings; etc., can be placed on-feverse side). IR DE I�Alkt I'ENTtUl t ONLY APPLICATION ACCEPTED BY- ATE /fg REVIEWEDBY----------------------------------------- ------------------------------------------------------------------------------------ DATE------ r BUILDING PERMIT ISSUED Alterations and/or recommendations:, ---- - ------------- ------------------------------------------------ �71`� _ � �'�" ---------------------------- r --------... - - ------------- -------------------- ---- ------- ----------------------------------------- ----'----- - ------------------------ FINAL INST Y ----------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.